Evaluation of the Functional Impact of Coronary Stenoses in Diabetics by Spectral CT
Status:
Not yet recruiting
Trial end date:
2025-03-01
Target enrollment:
Participant gender:
Summary
The optimal screening methods for coronary insufficiency, a frequent and pejorative
complication in diabetics, are subject to debate, particularly in situations of silent
myocardial ischemia. The contemporary strategy consists of pre-selecting asymptomatic
patients at very high cardiovascular (CV) risk by performing a coronary calcium score. If
this is found to be high >300 AU (Agatston units), the patient is suspected of being at high
risk of silent myocardial ischemia (SMI), and the assessment is completed to exclude the
presence of coronary artery disease likely to benefit from revascularization.
The complementary evaluation consists in evaluating the myocardial perfusion to judge the
perfusion repercussions. The most common examination to date is myocardial scintigraphy,
because stress tests are too frequently submaximal in diabetics. However, the reproducibility
of scintigraphy is controversial and their sensitivity and specificity are debated in this
indication.
This problem is similar in stable symptomatic coronary diabetic patients for whom an
indication for functional examinations is justified.
The double-energy double-layer spectral scanner (SDEDC) could now become a relevant tool in
this field, since it can combine not only anatomical data (identification of coronary
stenosis) but also functional data (myocardial perfusion) during a stress protocol. thanks to
the spectral images which make it possible to measure the tissue concentration of
intramyocardial iodine downstream of the considered stenosis.